- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $5,011.87 / $5,888.44
| Facility | | $181.97 | $5,011.87 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $5,128.61
| Facility | 50 | $2,187.76 | $2,187.76 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $186.21 / $426.58
| Professional | | $57.54 | $186.21 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $181.97 / $1,621.81
| Professional | 50 | $89.13 | $181.97 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $208.93 / $524.81
| Professional | | $58.88 | $208.93 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $323.59 / $2,630.27
| Facility | | $54.95 | $323.59 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,187.76 / $3,235.94 / $5,370.32
| Facility | 50 | $2,187.76 | $3,235.94 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $295.12 / $1,071.52
| Professional | | $114.82 | $295.12 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $213.80 / $4,265.80
| Professional | 50 | $89.13 | $213.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $630.96 / $1,023.29
| Professional | | $234.42 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $295.12 / $1,071.52
| Facility | | $61.66 | $295.12 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $154.88 / $501.19
| Professional | | $60.26 | $154.88 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $281.84 / $851.14
| Professional | | $79.43 | $281.84 | $851.14 |